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Official Description

Thrombectomy, direct or with catheter; vena cava, iliac, femoropopliteal vein, by abdominal and leg incision

© Copyright 2026 American Medical Association. All rights reserved.

Common Language Description

Thrombectomy is a surgical procedure aimed at removing a thrombus, or blood clot, from specific veins in the body, particularly the vena cava, iliac vein, or femoropopliteal vein. This procedure can be performed directly or with the assistance of a catheter, depending on the location and nature of the thrombus. The procedure typically involves making incisions in the abdomen and/or leg to access the affected vein. A thrombus often forms in areas where the vein is narrowed or stenotic, which can impede blood flow and lead to complications. During the thrombectomy, the surgeon makes an incision in the abdomen and/or leg or groin to expose the vein and access the planned venotomy site. To control blood flow during the procedure, vessel loops are placed both proximal and distal to the thrombus. The vein is then incised, allowing for direct removal of the thrombus through the incision. Alternatively, if a catheter is used, a balloon catheter may be inserted through a venotomy at a site beyond the thrombus. This catheter is passed beyond the clot, inflated, and then withdrawn, effectively capturing and removing the thrombus. After the thrombus is removed, a venography may be performed to confirm that the entire clot has been successfully extracted and that the vein is patent, meaning it is open and unobstructed. It is important to note that specific CPT codes are designated for different approaches to thrombectomy, such as using an abdominal incision alone or a leg incision alone, with CPT® Code 34451 specifically indicating the use of both abdominal and leg incisions for the procedure.

© Copyright 2026 Coding Ahead. All rights reserved.

1. Indications

The thrombectomy procedure is indicated for the removal of thrombus in specific venous locations, particularly when there is a risk of complications due to impaired blood flow. The following conditions may warrant the performance of this procedure:

  • Thrombus in the Vena Cava - A thrombus located in the vena cava can lead to significant complications, including venous obstruction and potential embolism.
  • Thrombus in the Iliac Vein - Similar to the vena cava, a thrombus in the iliac vein can obstruct blood flow and may require intervention to prevent further complications.
  • Thrombus in the Femoropopliteal Vein - A thrombus in this area can cause pain, swelling, and other symptoms related to venous insufficiency, necessitating removal to restore normal blood flow.

2. Procedure

The thrombectomy procedure involves several critical steps to ensure effective removal of the thrombus. The following procedural steps outline the process:

  • Step 1: Incision - The procedure begins with the surgeon making an incision in the abdomen and/or leg or groin to access the affected vein. The choice of incision depends on the location of the thrombus and the surgical approach required.
  • Step 2: Vessel Loop Placement - Once the vein is accessed, vessel loops are placed both proximal and distal to the thrombus. This step is crucial as it helps control blood flow during the procedure, allowing for a clear working area.
  • Step 3: Vein Incision - The surgeon then incises the vein at the planned venotomy site, providing direct access to the thrombus. This incision allows for the removal of the clot through direct exposure.
  • Step 4: Thrombus Removal - The thrombus is carefully removed from the vein. In cases where a catheter is utilized, a balloon catheter may be inserted through a venotomy at a site beyond the thrombus. The catheter is passed beyond the clot, inflated, and then withdrawn, capturing the thrombus for removal.
  • Step 5: Venography - After the thrombus has been removed, a venography may be performed to ensure that the entire clot has been successfully extracted and that the vein is patent, confirming that normal blood flow has been restored.

3. Post-Procedure

Following the thrombectomy procedure, patients may require monitoring for any complications related to the surgery. Expected recovery may include managing pain at the incision sites and monitoring for signs of bleeding or infection. Patients may also undergo follow-up imaging studies to confirm the success of the procedure and ensure that the vein remains patent. Additional considerations may include recommendations for lifestyle modifications or anticoagulation therapy to prevent future thrombus formation, although specific post-procedure care instructions should be tailored to the individual patient's needs and the surgeon's protocols.

Short Descr REMOVAL OF VEIN CLOT
Medium Descr THRMBC DIR/W/CATH V/C ILIAC FEMPOP VEIN ABDL&LEG
Long Descr Thrombectomy, direct or with catheter; vena cava, iliac, femoropopliteal vein, by abdominal and leg incision
Status Code Active Code
Global Days 090 - Major Surgery
PC/TC Indicator (26, TC) 0 - Physician Service Code
Multiple Procedures (51) 2 - Standard payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50) 1 - 150% payment adjustment for bilateral procedures applies.
Physician Supervisions 09 - Concept does not apply.
Assistant Surgeon (80, 82) 2 - Payment restriction for assistants at surgery does not apply to this procedure...
Co-Surgeons (62) 1 - Co-surgeons could be paid, though supporting documentation is required...
Team Surgery (66) 0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family 99 - Concept Does Not Apply
APC Status Indicator Inpatient Procedures, not paid under OPPS
Type of Service (TOS) 2 - Surgery
Berenson-Eggers TOS (BETOS) P2F - Major procedure, cardiovascular-Other
MUE 1
CCS Clinical Classification 60 - Embolectomy and endarterectomy of lower limbs
51 Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d).
RT Right side (used to identify procedures performed on the right side of the body)
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Pre-1990 Added Code added.
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